Provider Demographics
NPI:1457843963
Name:YOUNG, DANIELLE CORINE (PA)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:CORINE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-355-6000
Mailing Address - Fax:
Practice Address - Street 1:101 PLAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4829
Practice Address - Country:US
Practice Address - Phone:401-736-4592
Practice Address - Fax:401-889-5008
Is Sole Proprietor?:No
Enumeration Date:2018-05-31
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA6973363AS0400X
CT363AS0400X
RIPA01391363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical